Implementation of a remission diet for type 2 diabetes in South Asia: Qualitative evidence from the HoDiRECT Nepal...

Efforts to achieve type 2 diabetes (T2D) remission by weight loss using low-calorie diets are gaining momentum, mainly in high-income countries. The HoDiRECT Nepal project demonstrated the feasibility of a low-calorie traditional Nepali diet for diabetes remission. This qualitative substudy explored the factors affecting its implementation.

HoDiRECT participants who had completed 8 weeks of a low-calorie diet were invited to participate in one-to-one interviews at follow-up visits. The interviews were guided by a predesigned interview protocol and conducted in Nepali. The interviews were audio recorded, transcribed verbatim and analysed using a thematic framework approach.

Interviews with 16 participants confirmed general acceptability of the intervention. Participants' motivation to enrol in the programme was driven by their desire to stop taking diabetes medications, achieve better diabetes control and lose weight. Understanding diabetes, its complications and the perceived value of diet influenced their decision to adhere to the programme. Adherence was facilitated by the ability to prepare food or have someone to do so, clear information about the diet and continued guidance. Participants found adherence difficult during travel and on social/cultural occasions. Healthcare professionals' involvement had a positive value, but popular beliefs, often false, about food for diabetes influenced participants' dietary behaviour.

Adherence to a weight-loss regimen can be enhanced if the diet is simple to prepare and if there is greater education for patients and their communities about diabetes, highlighting the effectiveness of diet as a treatment, with clear and consistent messaging about dietary practices.